Research has found frequent exposure to tobacco use in TV shows and movies can make an adolescent three times more likely to use tobacco products themselves.

Experts say chipping away at on-screen tobacco use in movies and TV shows is an important part of the effort to eliminate tobacco use among youth.

For the second year in a row, Netflix topped the list of 13 broadcast, cable, and streaming services for the number of tobacco depictions that appeared on-screen. But for the first time ever, the streaming service responded by vowing to make a change.

The list was part of a report released by the Truth Initiative, a nonprofit public health organization committed to eliminating tobacco use in the United States.

This report is driven by the fact that research has found frequent exposure to tobacco use in television and movies can make an adolescent three times more likely to use tobacco products themselves.

The Truth Initiative has long called for television creators and filmmakers to keep tobacco use out of content rated PG-13 or lower, backed up by the U.S. surgeon general, who has said that “the adoption of such policies would contribute to a reduction in adolescent smoking behavior.”

With 2019 representing yet another dramatic increase in on-screen tobacco use — a 176 percent increase from 2018 overall, and a 379 percent increase in youth-rated programing — Netflix’s “Stranger Things”was the worst offender, with tobacco use depicted in every single episode.

It seems Netflix has finally taken the criticism to heart. Just days after the most recent Truth Initiative report, the streaming giant promised, “Going forward, all new projects that we commission with ratings of TV-14 or below for series or PG-13 or below for films, will be smoking and e-cigarette free — except for reasons of historical or factual accuracy.”

“I do think the policy needs to go further,” Robin Koval, CEO and president of the Truth Initiative, told Healthline. “They haven’t released it formally, so they should do that publicly. Then of course we could comment on the policy and help them to make it stronger.”

But ultimately, she said she’s happy to see progress. “I’m pleased to see they are listening. And having the No. 1 streaming service do this will hopefully encourage others to do the same. But of course, enforcement is the biggest thing. We’ll have to see how well it’s enforced.”

It’s a good step forward for the effort to eliminate tobacco use among youth, but Michael Tynan, public health analyst in the CDC’s Office on Smoking and Health, told Healthline that while chipping away at tobacco use on-screen is important, there are other steps that need to be made as well.

Tynan provided a list of ways parents can help influence how their children might approach tobacco use:

Avoid using tobacco products yourself.

Be clear that you don’t approve of smoking and that you expect your child to live tobacco-free.

Tell your children that many kids don’t smoke, and talk with them about what nicotine addiction can cost them as they get older.

Make your home and your car tobacco-free zones for everyone — family, friends, and visitors — and prohibit the use of all tobacco products.

Make sure your children’s schools enforce tobacco-free policies on campus and at all school-sponsored events.

If your child is using tobacco, find a smoking cessation program to help them quit. Nicotine is highly addictive. Even experimenting with cigarettes one time increases your child’s chance of nicotine addiction. You can start by talking with your child’s doctor.

John Mopper is an adolescent therapist with Blueprint Mental Health. He recently told Healthline, “I personally sit across from 20 to 30 children and teens every week.” While he says smoking cigarettes has mostly gone out of style, “It’s just not cool anymore,” he explained that vaping is definitely on the rise.

When it comes to how parents should approach the topic of tobacco use with their kids, he said, “Parents need to really put themselves in their children’s shoes and validate their situation.”

That may mean telling them you understand the pressure to experiment and the strong desire to be accepted by their peers, while also ensuring they fully understand the negatives of tobacco use.

He discourages relying purely on consequences to keep children in line when it comes to nicotine.

“Sure, there need to be limits and boundaries set,” he explained. “But a solid, open relationship needs to be established in order to balance out those limits and boundaries.”

Koval agreed, telling Healthline that finding out your child has been using nicotine products isn’t the time to punish or yell, “Especially because, with high nicotine products like Juuls, what they really need is help.”

There are a number of programs available to help adolescents find help for nicotine addiction.

In fact, the Truth Initiative has a program geared specifically toward adolescents called “This Is Quitting.”

By texting “DITCHJUUL” to 887-09, teens can receive free support and resources “to help with cravings, stress, and slips.”

All three experts Healthline spoke to agreed that one of the best ways parents can help their children to avoid becoming tobacco users is to not use tobacco themselves. But for those parents who already do, there are ways to help your children avoid trying tobacco.

“You can influence your child’s decision on whether to smoke,” Tynan explained. “Even if you use tobacco yourself, your child will listen if you discuss your struggles with nicotine addiction and your regrets about starting smoking in the first place.”

Mopper agreed, saying that, “Parents need to be vulnerable with their own emotions and struggles. Being able to say, ‘Hey, I get that it seems weird that I’m smoking and telling you not to. If I could go back and never start, I would. We all make mistakes in life, and starting smoking was one of mine.’”

He says parents can then use that opportunity to speak to how and why they started, and how it negatively affects them today.

For parents who want to quit, though, the Truth Initiative has a program for you, too.

“BecomeAnEx is a free online community which has been used by over 800,000 adults on their journey to quit,” Koval said proudly, also pointing out that it often takes many attempts to fully quit.

“Part of this process is often going through it, failing, learning from it, and trying again,” she explained. “That’s the most important thing for parents to do. Certainly every home should be a smoke-free home.”

With Netflix’s latest move to reduce on-screen smoking, it’s possible more homes may be able to claim that status in the future, too.